Renal and urology Flashcards by Aneesa Sheikh

How might babies with UTIs present

Fever

Lethargy

Irritability

Vomiting

Poor feeding

Urinary frequency

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How might infants and children present with UTIs

Fever

Suprapubic abdominal pain

Vomiting

Dysuria

Urinary frequency

Incontinence

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How might a patient with acute pyelonephritis present

Temperature > 38

Loin pain and tenderness

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What investigations are needed for UTIs

Urine dip (clean catch sample)

If recurrent

Ultrasound (all under 6 months within 6 weeks)
DMSA (scan 4-6 months after illness, look for damage)
Micturition cystourethrogram (look for vesico-ureteric reflux)

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What is the management for babies under 3 months with a UTI

Immediate IV antibiotics (ceftriaxone)

Full septic screen

Consider lumbar puncture

(Applies to all under 3 months with a fever, regardless of suspected cause)

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What is the management of UTIs in children over 3 months

Consider antibiotics (trimethoprim, nitrofurantoin, cefalexin, amoxicillin)

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What is vulvovaginitis

Inflammation and irritation of vulva and vagina

Common in girls 3-10 (less common after puberty, as oestrogen protects skin and mucosa)

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What are the exacerbating factors for vulvovaginitis

Wet nappies

Use of soap in the area

Tight clothing that traps moisture

Poor toilet hygiene

Constipation

Threadworms

Pressure on area

Heavily chlorinated pools

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How might a child with vulvovaginitis present

Soreness

Itching

Erythema around labia

Vaginal discharge

Dysuria

Constipation

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What are the investigations for vulvovaginitis

Urine dip (leukocytes, but no nitrates)

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What is the management for vulvovaginitis

Usually only need to avoid exacerbating factors

Oestrogen cream for severe cases

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What is nephrotic syndrome

Basement membrane in glomerulus becomes highly permeable to protein

Most common in 2-5s

Classic triad: hypoalbuminaemia, proteinuria, oedema

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How might a patient with nephrotic syndrome present

Frothy urine

Generalised oedema

Pallor

Deranged lipid profile

Hypertension

Hypercoagulability

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What are the causes of nephrotic syndrome in children

Minimal change disease (treated with prednisolone)

Focal segmental glomerulosclerosis

Membranoproliferative glomerulonephritis

Diabetes

Infection

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What is the management for nephrotic syndrome

High dose steroids (prednisolone, for 4 weeks, wean over 8 weeks)

Low salt diet

Diuretics

Consider albumin infusion

Consider prophylactic antibiotics

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What are the complications of nephrotic syndrome

Hypovolaemia

Thrombosis

Infection

Acute or chronic renal failure

Relapse

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What is nephritis

Inflammation within nephrons of kidney

Classic triad of: reduced kidney function, haematuria, proteinuria

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What are the common causes of nephritis in children

Post-streptococcal glomerulonephritis (1-3 weeks after group B strep infection, get AKI, supportive management, consider antihypertensives and diuretics)

IgA nephropathy (in teens, treat with immunosuppressants (steroids slow progression of disease))

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What is haemolytic uraemic syndrome

Thrombosis within small blood vessels throughout body

Triggered by shiga toxin (E coli 0157)

Classic triad of: haemolytic anaemia, AKI, thrombocytopenia

A medical emergency

How might a patient with haemolytic uraemic syndrome present

Around 5 days after onset of diarrhoea

Reduced urine output

Haematuria or dark brown urine

Abdominal pain

Lethargy

Irritability

Confusion

Oedema

Hypertension

Bruising

What is the management for haemolytic uraemic syndrome

Supportive care

Consider urgent referral for dialysis

Blood transfusion if needed

What is enuresis

Involuntary urination

Most children out of daytime urination by age 2

Most children out of night time urination by age 3-4

What is primary nocturnal enuresis

Child has never managed to stay dry consistently at night

Usually part of normal development

What are the causes of primary nocturnal enuresis

Normal development

Overactive bladder

Fluid intake before bed

Failure to wake up due to deep sleep

Psychological distress

Secondary causes (chronic constipation, UTIs, learning disability, cerebral palsy)

What is the management for primary nocturnal enuresis

Reassure parents that it will likely resolve by age 5 Less fluid in evening Encouragement and positive reinforcement Treat underlying cause Enuresis alarm Pharmacological treatment

What is secondary enuresis

Wetting bed when previously dry for 6 months Possible causes: UTI, constipation, T1DM, new psychosocial problem, maltreatment, consider abuse and safeguarding Treat underlying cause

What is diurnal enuresis

Dry at night, but occasionally incontinent during the day Mostly in girls Causes: urge incontinence, stress incontinence, recurrent UTIs, psychosocial problems, constipation

What are the pharmacological managements for enuresis

Desmopressin (ADH analogue, reduces volume of urine produced) Oxybutynin (anticholinergic, reduces contractility of bladder) Imipramine (tricyclic antidepressant, relaxes bladder and lightens sleep)

What is autosomal recessive polycystic kidney disease

Presents in neonates Usually picked up on antenatal scanning Cystic enlargement of renal collecting ducts Oligohydramnios and pulmonary hypoplasia Congenital liver fibrosis May need dialysis in first few days of life May have end stage renal failure before starting school Poor prognosis (1/3 die as neonates)

What is a Wilms tumour

Tumour of the kidneys in children Usually affects under 5s

How might a patient with a Wilms tumour present

Mass in abdomen Abdominal pain Haematuria Lethargy Fever Hypertension Weight loss

What are the investigations for Wilms tumour

Ultrasound abdomen CT/MRI for staging Biopsy

What is the management for a Wilms tumour

Surgical excision (of tumour and kidney) Adjuvant chemotherapy and radiotherapy Good prognosis with early treatment

What is a posterior urethral valve

Tissue at proximal end of urethra, causes obstruction of urine flow In newborn males Can develop hydronephrosis Increased risk of UTIs

How might mild cases of posterior urethral valve present

Difficulty urinating Weak urine stream Chronic urinary retention Palpable bladder Recurrent UTIs Impaired kidney function

How might severe cases of posterior urethral valve present

Bilateral hydronephrosis Oligohydramnios (get underdeveloped fetal lungs, respiratory failure shortly after birth)

What are the investigations for posterior urethral valve

Picked up on antenatal ultrasound If presenting at birth: abdominal ultrasound, micturition cystourethrogram, cystoscopy

What is the management for posterior urethral valve

Mild: monitor, temporary urinary catheter Definitive management: ablation or removal (via cystoscopy)

What are the risk factors for undescended testis

Family history Low birth weight Small for gestational age Prematurity Maternal smoking during pregnancy

What is the management for undescended testis

Newborns: watch and wait (likely to descend by 3-6 months) If not descended by 6 months, orchidopexy (at 6-12 months)

What is hypospadias

Urethral meatus displaced to ventral side of penis (anywhere between further down glans to base of shaft) Have an abnormal foreskin Diagnosed during newborn examination

What is the management for hypospadias

Not to be circumcised until seen by a urologist Mild: no treatment needed Surgery: at 3-4 months (correct position of meatus, straighten penis)

What are the complications of hypospadias

Difficulty directing urine Cosmetic and psychological concerns Sexual dysfunction

What is a hydrocele

Collection of fluid in tunica vaginalis Simple: common in newborns, trapped fluid gets reabsorbed over time Communicating: tunica vaginalis connected to peritoneal cavity via processus vaginalis, size fluctuates over time

What are the investigations for hydrocele

Physical examination (soft, smooth, non-tender swelling, transilluminates)

What is the management for hydrocele

Simple: resolves by age 2 Communicating: surgery (remove or ligate processus vaginalis)